New to Diabetes: What’s Next? (Part 1)

Back in October, I posted a piece called “Getting Started With Type 2 Diabetes.” My intent with that was to provide you with an overview of what to do when you’re told you have diabetes (or what to do if you’ve had diabetes for a while but perhaps hadn’t been ready to manage it).

Now that we’re in a new year, I thought it might be helpful to expand upon that piece a bit. As you and I well know, taking care of your diabetes can seem like a full-time job, and if this is all new to you, it can be a bit bewildering trying to sort it all out. So in the spirit of new beginnings, this week I’ll share a couple more things to consider as you start your journey.

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Know your health plan
You don’t need me to tell you that having diabetes can be rather costly. Medicine and diabetes supplies don’t come cheap, nor does diabetes education. Health-care plans vary in terms of their premiums, deductibles, and co-payments. They also tend to dictate what type of blood glucose meter strips and medicine they’ll cover, as well as what types of diabetes services they’ll cover, and where. Before you make an appointment with a diabetes specialist or purchase a particular meter, do some research on your health-care plan. Specifically, find out about the following:

• Premiums
• Co-payments for provider visits, medicines, and diabetes supplies
• The amount of supplies you can get at one time
• Where you can purchase your supplies
• Coverage for diabetes medicines and any prescription plans that they offer
• Coverage for services provided by specialists (endocrinologists, cardiologists, podiatrists, eye doctors, etc.)
• Coverage for diabetes education (either individually or in a group setting)
• Coverage for nutrition education provided by a dietitian

If you’re having trouble paying for supplies, first talk to your health-care provider. He may be able to prescribe a lower-cost and/or generic type of diabetes pill or insulin. If you take two different types of diabetes pills, ask your provider about taking a combination pill, which can be less expensive. Some drug manufacturers provide medicine assistance programs for people who have difficulty affording their medicine; to find out if the manufacturer of your medicines has such a program, call the company or check out their Web site.

Some pharmacies offer their own brand of blood glucose meter, which typically use less-expensive test strips. If possible, ordering supplies in bulk and ordering your supplies by mail rather than picking them up at the local pharmacy can also cut down on expenses. As far as saving money on medical care and education, explore programs or clinics in your community. They may provide free services or offer payment on a sliding scale basis.

Know your diabetes medicine
If you’re diagnosed with Type 1 diabetes, you’ll need to take insulin to survive. With Type 2 diabetes, however, treatment is less clear-cut.

Much of it depends on how long you’ve actually had diabetes and what your blood glucose and A1C levels are at the time of diagnosis. I realize that most people prefer not to take medicine (and who does?). But treatment protocols for Type 2 diabetes generally advise starting on medicine at or shortly after diagnosis.

Usually, the first choice of medicine is metformin. Metformin is a very safe and effective drug for managing blood glucose levels. However, there are many other types of diabetes medicines, as well (not including insulin). Some pills lower blood glucose by stimulating the pancreas to release insulin. These drugs increase the risk of low blood glucose (hypoglycemia). Other drugs work by slowing the breakdown of carbohydrate in the digestive tract. There are eight different classes of diabetes pills, so talk to your provider about which ones are best for you.

In addition, there are injectable medications — exenatide (brand name Byetta), liraglutide (Victoza), exenatide extended-release for injectable suspension (Bydureon), pramlintide (Symlin) — that aren’t insulin, but that can be very effective in helping you manage your blood glucose and possibly even lose weight at the same time.

Keep in mind, too, that some people with Type 2 diabetes may need to start on insulin right at diagnosis, or shortly thereafter. This is perfectly normal and is not a “bad” thing. What’s most important is that you’re able to safely and effectively meet your blood glucose and A1C targets most of the time. Don’t forget that meal planning and physical activity are part of the equation, too.

• How does this medicine work to lower my blood glucose and A1C?
• How do I take it (for example, in pill form or as an injectable)?
• How much do I take?
• Do I take this with food or on an empty stomach?
• What do I do if I miss a dose?
• What are the possible side effects and if they occur, what should I do?
• Is low blood glucose a side effect and if so, how do I prevent and treat it?
• Does this medicine interact with other medicines and/or dietary supplements that I take?
• How will I know if this medicine is working for me?
• When should I check my blood glucose to see if it’s working?

Remember: The more you know about your treatment plan, the better you’ll feel about having diabetes. Do your homework and ask a lot of questions.

More next week!

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Steve Parker, M.D.

Perhaps I’m wrong, but I count 11 classes of drugs for diabetes, not 8. When I started my medical career, there were only three classes, if memory serves me well: insulin, metformin, sulfonylureas in 1981.

Thanks, Steve. You’re right, there are 11 classes of diabetes medicines, but as I wrote, I was referring to 8 classes of diabetes pills.

Teri

I really struggle because I do not have time to cook and I need a list of foods tht a person can eat that is basially on the run with no refrig and I eat out alot. Is there suggestions for people like me? I do not have much time at home.
Is there a list of YES foods?

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